|
PEGGED GLENOID POLY W/PEG LARGE
|
Facility
IP
|
$2,835.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
8047277
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,984.50 |
| Max. Negotiated Rate |
$2,551.50 |
| Rate for Payer: Aetna of IA Commercial |
$2,551.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$2,551.50
|
| Rate for Payer: Cash Price |
$2,268.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$2,126.25
|
| Rate for Payer: Medical Associates Commercial |
$2,126.25
|
| Rate for Payer: Midlands Choice Commercial |
$1,984.50
|
| Rate for Payer: United Healthcare Commercial |
$2,551.50
|
|
|
PEGGED GLENOID POLY W/PEG LARGE
|
Facility
OP
|
$2,835.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
8047277
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,416.93 |
| Max. Negotiated Rate |
$2,551.50 |
| Rate for Payer: Aetna of IA Commercial |
$2,551.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$2,551.50
|
| Rate for Payer: Aetna of IA Medicare |
$1,615.95
|
| Rate for Payer: Amerigroup Medicaid |
$1,430.82
|
| Rate for Payer: Amerigroup Medicare |
$1,431.68
|
| Rate for Payer: Cash Price |
$2,268.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$2,126.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$1,417.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1,416.93
|
| Rate for Payer: Medical Associates Commercial |
$2,126.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$1,417.50
|
| Rate for Payer: Midlands Choice Commercial |
$1,984.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1,438.76
|
| Rate for Payer: Partners Health Alliance Commercial |
$2,126.25
|
| Rate for Payer: United Healthcare Commercial |
$2,551.50
|
| Rate for Payer: United Healthcare Managed Medicare |
$1,672.65
|
|
|
PEGGED GLENOID POLY W/PEG MEDIUM
|
Facility
OP
|
$2,835.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
8047276
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,416.93 |
| Max. Negotiated Rate |
$2,551.50 |
| Rate for Payer: Aetna of IA Commercial |
$2,551.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$2,551.50
|
| Rate for Payer: Aetna of IA Medicare |
$1,615.95
|
| Rate for Payer: Amerigroup Medicaid |
$1,430.82
|
| Rate for Payer: Amerigroup Medicare |
$1,431.68
|
| Rate for Payer: Cash Price |
$2,268.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$2,126.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$1,417.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1,416.93
|
| Rate for Payer: Medical Associates Commercial |
$2,126.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$1,417.50
|
| Rate for Payer: Midlands Choice Commercial |
$1,984.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1,438.76
|
| Rate for Payer: Partners Health Alliance Commercial |
$2,126.25
|
| Rate for Payer: United Healthcare Commercial |
$2,551.50
|
| Rate for Payer: United Healthcare Managed Medicare |
$1,672.65
|
|
|
PEGGED GLENOID POLY W/PEG MEDIUM
|
Facility
IP
|
$2,835.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
8047276
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,984.50 |
| Max. Negotiated Rate |
$2,551.50 |
| Rate for Payer: Aetna of IA Commercial |
$2,551.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$2,551.50
|
| Rate for Payer: Cash Price |
$2,268.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$2,126.25
|
| Rate for Payer: Medical Associates Commercial |
$2,126.25
|
| Rate for Payer: Midlands Choice Commercial |
$1,984.50
|
| Rate for Payer: United Healthcare Commercial |
$2,551.50
|
|
|
PEGGED GLENOID POLY W/PEG SMALL
|
Facility
IP
|
$2,835.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
8047275
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,984.50 |
| Max. Negotiated Rate |
$2,551.50 |
| Rate for Payer: Aetna of IA Commercial |
$2,551.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$2,551.50
|
| Rate for Payer: Cash Price |
$2,268.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$2,126.25
|
| Rate for Payer: Medical Associates Commercial |
$2,126.25
|
| Rate for Payer: Midlands Choice Commercial |
$1,984.50
|
| Rate for Payer: United Healthcare Commercial |
$2,551.50
|
|
|
PEGGED GLENOID POLY W/PEG SMALL
|
Facility
OP
|
$2,835.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
8047275
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,416.93 |
| Max. Negotiated Rate |
$2,551.50 |
| Rate for Payer: Aetna of IA Commercial |
$2,551.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$2,551.50
|
| Rate for Payer: Aetna of IA Medicare |
$1,615.95
|
| Rate for Payer: Amerigroup Medicaid |
$1,430.82
|
| Rate for Payer: Amerigroup Medicare |
$1,431.68
|
| Rate for Payer: Cash Price |
$2,268.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$2,126.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$1,417.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1,416.93
|
| Rate for Payer: Medical Associates Commercial |
$2,126.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$1,417.50
|
| Rate for Payer: Midlands Choice Commercial |
$1,984.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1,438.76
|
| Rate for Payer: Partners Health Alliance Commercial |
$2,126.25
|
| Rate for Payer: United Healthcare Commercial |
$2,551.50
|
| Rate for Payer: United Healthcare Managed Medicare |
$1,672.65
|
|
|
Pelvic Evisceration, Radical Hysterectomy and Radical Vulvectomy With CC/MCC
|
Facility
IP
|
$16,834.47
|
|
|
Service Code
|
MS-DRG 734
|
| Hospital Charge Code |
495
|
| Min. Negotiated Rate |
$2,034.00 |
| Max. Negotiated Rate |
$16,834.47 |
| Rate for Payer: Amerigroup Medicaid |
$16,753.15
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$2,034.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$16,590.49
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$16,834.47
|
|
|
Pelvic Evisceration, Radical Hysterectomy and Radical Vulvectomy Without CC/MCC
|
Facility
IP
|
$16,294.12
|
|
|
Service Code
|
MS-DRG 735
|
| Hospital Charge Code |
496
|
| Min. Negotiated Rate |
$2,034.00 |
| Max. Negotiated Rate |
$16,294.12 |
| Rate for Payer: Amerigroup Medicaid |
$16,215.40
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$2,034.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$16,057.97
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$16,294.12
|
|
|
pembrolizumab 100mg/4ml SDV
|
Facility
OP
|
$20,184.72
|
|
|
Service Code
|
CPT J9271
|
| Hospital Charge Code |
43700520
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10,088.32 |
| Max. Negotiated Rate |
$18,166.25 |
| Rate for Payer: Aetna of IA Commercial |
$18,166.25
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$18,166.25
|
| Rate for Payer: Aetna of IA Medicare |
$11,505.29
|
| Rate for Payer: Amerigroup Medicaid |
$10,187.23
|
| Rate for Payer: Amerigroup Medicare |
$10,193.28
|
| Rate for Payer: Cash Price |
$16,147.78
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$15,138.54
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$10,092.36
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$10,088.32
|
| Rate for Payer: Medical Associates Commercial |
$15,138.54
|
| Rate for Payer: Medical Associates Managed Medicare |
$10,092.36
|
| Rate for Payer: Midlands Choice Commercial |
$14,129.30
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$10,243.75
|
| Rate for Payer: Partners Health Alliance Commercial |
$15,138.54
|
| Rate for Payer: United Healthcare Commercial |
$18,166.25
|
| Rate for Payer: United Healthcare Managed Medicare |
$11,908.98
|
|
|
pembrolizumab 100mg/4ml SDV
|
Facility
IP
|
$20,184.72
|
|
|
Service Code
|
CPT J9271
|
| Hospital Charge Code |
43700520
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$14,129.30 |
| Max. Negotiated Rate |
$18,166.25 |
| Rate for Payer: Aetna of IA Commercial |
$18,166.25
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$18,166.25
|
| Rate for Payer: Cash Price |
$16,147.78
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$15,138.54
|
| Rate for Payer: Medical Associates Commercial |
$15,138.54
|
| Rate for Payer: Midlands Choice Commercial |
$14,129.30
|
| Rate for Payer: United Healthcare Commercial |
$18,166.25
|
|
|
penicillin G benzathine 1,200,000 units/2 mL SDS Sus
|
Facility
IP
|
$1,073.50
|
|
|
Service Code
|
CPT J0561
|
| Hospital Charge Code |
43701118
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$751.45 |
| Max. Negotiated Rate |
$966.15 |
| Rate for Payer: Aetna of IA Commercial |
$966.15
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$966.15
|
| Rate for Payer: Cash Price |
$858.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$805.12
|
| Rate for Payer: Medical Associates Commercial |
$805.12
|
| Rate for Payer: Midlands Choice Commercial |
$751.45
|
| Rate for Payer: United Healthcare Commercial |
$966.15
|
|
|
penicillin G benzathine 1,200,000 units/2 mL SDS Sus
|
Facility
OP
|
$1,073.50
|
|
|
Service Code
|
CPT J0561
|
| Hospital Charge Code |
43701118
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$536.54 |
| Max. Negotiated Rate |
$966.15 |
| Rate for Payer: Aetna of IA Commercial |
$966.15
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$966.15
|
| Rate for Payer: Aetna of IA Medicare |
$611.90
|
| Rate for Payer: Amerigroup Medicaid |
$541.80
|
| Rate for Payer: Amerigroup Medicare |
$542.12
|
| Rate for Payer: Cash Price |
$858.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$805.12
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$536.75
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$536.54
|
| Rate for Payer: Medical Associates Commercial |
$805.12
|
| Rate for Payer: Medical Associates Managed Medicare |
$536.75
|
| Rate for Payer: Midlands Choice Commercial |
$751.45
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$544.80
|
| Rate for Payer: Partners Health Alliance Commercial |
$805.12
|
| Rate for Payer: United Healthcare Commercial |
$966.15
|
| Rate for Payer: United Healthcare Managed Medicare |
$633.36
|
|
|
Penicillin G Potassium 5,000,000 units Pow
|
Facility
IP
|
$34.89
|
|
|
Service Code
|
CPT J2540
|
| Hospital Charge Code |
43702489
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$24.42 |
| Max. Negotiated Rate |
$31.40 |
| Rate for Payer: Aetna of IA Commercial |
$31.40
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$31.40
|
| Rate for Payer: Cash Price |
$27.91
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$26.17
|
| Rate for Payer: Medical Associates Commercial |
$26.17
|
| Rate for Payer: Midlands Choice Commercial |
$24.42
|
| Rate for Payer: United Healthcare Commercial |
$31.40
|
|
|
Penicillin G Potassium 5,000,000 units Pow
|
Facility
OP
|
$34.89
|
|
|
Service Code
|
CPT J2540
|
| Hospital Charge Code |
43702489
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$17.44 |
| Max. Negotiated Rate |
$31.40 |
| Rate for Payer: Aetna of IA Commercial |
$31.40
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$31.40
|
| Rate for Payer: Aetna of IA Medicare |
$19.89
|
| Rate for Payer: Amerigroup Medicaid |
$17.61
|
| Rate for Payer: Amerigroup Medicare |
$17.62
|
| Rate for Payer: Cash Price |
$27.91
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$26.17
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$17.44
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$17.44
|
| Rate for Payer: Medical Associates Commercial |
$26.17
|
| Rate for Payer: Medical Associates Managed Medicare |
$17.44
|
| Rate for Payer: Midlands Choice Commercial |
$24.42
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$17.71
|
| Rate for Payer: Partners Health Alliance Commercial |
$26.17
|
| Rate for Payer: United Healthcare Commercial |
$31.40
|
| Rate for Payer: United Healthcare Managed Medicare |
$20.59
|
|
|
Penicillin V Potassium 250mg Tab
|
Facility
OP
|
$1.27
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43799919
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.63 |
| Max. Negotiated Rate |
$1.14 |
| Rate for Payer: Aetna of IA Commercial |
$1.14
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.14
|
| Rate for Payer: Aetna of IA Medicare |
$0.72
|
| Rate for Payer: Amerigroup Medicaid |
$0.64
|
| Rate for Payer: Amerigroup Medicare |
$0.64
|
| Rate for Payer: Cash Price |
$1.02
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$0.95
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$0.64
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$0.63
|
| Rate for Payer: Medical Associates Commercial |
$0.95
|
| Rate for Payer: Medical Associates Managed Medicare |
$0.64
|
| Rate for Payer: Midlands Choice Commercial |
$0.89
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$0.64
|
| Rate for Payer: Partners Health Alliance Commercial |
$0.95
|
| Rate for Payer: United Healthcare Commercial |
$1.14
|
| Rate for Payer: United Healthcare Managed Medicare |
$0.75
|
|
|
Penicillin V Potassium 250mg Tab
|
Facility
IP
|
$1.27
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43799919
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.89 |
| Max. Negotiated Rate |
$1.14 |
| Rate for Payer: Aetna of IA Commercial |
$1.14
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.14
|
| Rate for Payer: Cash Price |
$1.02
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$0.95
|
| Rate for Payer: Medical Associates Commercial |
$0.95
|
| Rate for Payer: Midlands Choice Commercial |
$0.89
|
| Rate for Payer: United Healthcare Commercial |
$1.14
|
|
|
Penis Procedures With CC/MCC
|
Facility
IP
|
$22,760.58
|
|
|
Service Code
|
MS-DRG 709
|
| Hospital Charge Code |
476
|
| Min. Negotiated Rate |
$2,034.00 |
| Max. Negotiated Rate |
$22,760.58 |
| Rate for Payer: Amerigroup Medicaid |
$22,650.63
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$2,034.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$22,430.72
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$22,760.58
|
|
|
Penis Procedures Without CC/MCC
|
Facility
IP
|
$10,846.34
|
|
|
Service Code
|
MS-DRG 710
|
| Hospital Charge Code |
477
|
| Min. Negotiated Rate |
$2,034.00 |
| Max. Negotiated Rate |
$10,846.34 |
| Rate for Payer: Amerigroup Medicaid |
$10,793.95
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$2,034.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$10,689.15
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$10,846.34
|
|
|
pentoxifylline 400 mg ER Tab
|
Facility
OP
|
$1.61
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43701346
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.80 |
| Max. Negotiated Rate |
$1.45 |
| Rate for Payer: Aetna of IA Commercial |
$1.45
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.45
|
| Rate for Payer: Aetna of IA Medicare |
$0.92
|
| Rate for Payer: Amerigroup Medicaid |
$0.81
|
| Rate for Payer: Amerigroup Medicare |
$0.81
|
| Rate for Payer: Cash Price |
$1.29
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.21
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$0.81
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$0.80
|
| Rate for Payer: Medical Associates Commercial |
$1.21
|
| Rate for Payer: Medical Associates Managed Medicare |
$0.81
|
| Rate for Payer: Midlands Choice Commercial |
$1.13
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$0.82
|
| Rate for Payer: Partners Health Alliance Commercial |
$1.21
|
| Rate for Payer: United Healthcare Commercial |
$1.45
|
| Rate for Payer: United Healthcare Managed Medicare |
$0.95
|
|
|
pentoxifylline 400 mg ER Tab
|
Facility
IP
|
$1.61
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43701346
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.13 |
| Max. Negotiated Rate |
$1.45 |
| Rate for Payer: Aetna of IA Commercial |
$1.45
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.45
|
| Rate for Payer: Cash Price |
$1.29
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.21
|
| Rate for Payer: Medical Associates Commercial |
$1.21
|
| Rate for Payer: Midlands Choice Commercial |
$1.13
|
| Rate for Payer: United Healthcare Commercial |
$1.45
|
|
|
peramivir
|
Facility
IP
|
$1,286.67
|
|
|
Service Code
|
CPT C9451
|
| Hospital Charge Code |
43700410
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$900.67 |
| Max. Negotiated Rate |
$1,158.00 |
| Rate for Payer: Aetna of IA Commercial |
$1,158.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,158.00
|
| Rate for Payer: Cash Price |
$1,029.33
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$965.00
|
| Rate for Payer: Medical Associates Commercial |
$965.00
|
| Rate for Payer: Midlands Choice Commercial |
$900.67
|
| Rate for Payer: United Healthcare Commercial |
$1,158.00
|
|
|
peramivir
|
Facility
OP
|
$1,286.67
|
|
|
Service Code
|
CPT C9451
|
| Hospital Charge Code |
43700410
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$643.08 |
| Max. Negotiated Rate |
$1,158.00 |
| Rate for Payer: Aetna of IA Commercial |
$1,158.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,158.00
|
| Rate for Payer: Aetna of IA Medicare |
$733.40
|
| Rate for Payer: Amerigroup Medicaid |
$649.38
|
| Rate for Payer: Amerigroup Medicare |
$649.77
|
| Rate for Payer: Cash Price |
$1,029.33
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$965.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$643.34
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$643.08
|
| Rate for Payer: Medical Associates Commercial |
$965.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$643.34
|
| Rate for Payer: Midlands Choice Commercial |
$900.67
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$652.99
|
| Rate for Payer: Partners Health Alliance Commercial |
$965.00
|
| Rate for Payer: United Healthcare Commercial |
$1,158.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$759.14
|
|
|
peramivir 20 mg/mL 20ml SDV Sol
|
Facility
IP
|
$1,286.67
|
|
|
Service Code
|
CPT J2547
|
| Hospital Charge Code |
43700410
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$900.67 |
| Max. Negotiated Rate |
$1,158.00 |
| Rate for Payer: Aetna of IA Commercial |
$1,158.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,158.00
|
| Rate for Payer: Cash Price |
$1,029.33
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$965.00
|
| Rate for Payer: Medical Associates Commercial |
$965.00
|
| Rate for Payer: Midlands Choice Commercial |
$900.67
|
| Rate for Payer: United Healthcare Commercial |
$1,158.00
|
|
|
peramivir 20 mg/mL 20ml SDV Sol
|
Facility
OP
|
$1,286.67
|
|
|
Service Code
|
CPT J2547
|
| Hospital Charge Code |
43700410
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$643.08 |
| Max. Negotiated Rate |
$1,158.00 |
| Rate for Payer: Aetna of IA Commercial |
$1,158.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,158.00
|
| Rate for Payer: Aetna of IA Medicare |
$733.40
|
| Rate for Payer: Amerigroup Medicaid |
$649.38
|
| Rate for Payer: Amerigroup Medicare |
$649.77
|
| Rate for Payer: Cash Price |
$1,029.33
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$965.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$643.34
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$643.08
|
| Rate for Payer: Medical Associates Commercial |
$965.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$643.34
|
| Rate for Payer: Midlands Choice Commercial |
$900.67
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$652.99
|
| Rate for Payer: Partners Health Alliance Commercial |
$965.00
|
| Rate for Payer: United Healthcare Commercial |
$1,158.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$759.14
|
|
|
PERC IMPL NS ELECTRODE ARRAY EPIDURAL
|
Professional
|
$4,343.00
|
|
|
Service Code
|
CPT 63650
|
| Hospital Charge Code |
8015898
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$379.43 |
| Max. Negotiated Rate |
$3,040.10 |
| Rate for Payer: Aetna of IA Medicare |
$379.43
|
| Rate for Payer: Amerigroup Medicaid |
$392.33
|
| Rate for Payer: Cash Price |
$3,474.40
|
| Rate for Payer: Cash Price |
$3,474.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$455.32
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$387.02
|
| Rate for Payer: Medical Associates Commercial |
$720.92
|
| Rate for Payer: Medical Associates Managed Medicare |
$379.43
|
| Rate for Payer: Midlands Choice Commercial |
$3,040.10
|
| Rate for Payer: Partners Health Alliance Commercial |
$569.14
|
| Rate for Payer: Wellmark IA HMO |
$734.00
|
| Rate for Payer: Wellmark IA PPO |
$861.00
|
|
